<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<title>Bubble Affiliate Program</title>

<link href="../css/admin.css" rel="stylesheet" type="text/css">
<script src="../jscript/menuArrayAffiliate.php" language="javascript"></script>
<script src="../jscript/clock.js" language="javascript"></script>
</head>

<body onLoad="funClock();">
<?php include("header.php"); ?>
<table width="100%" border="0" cellspacing="25" cellpadding="0">
<tr>
<td valign="top" width="240"><div id="menu"><?php include("menu.php"); ?></div></td>
<td valign="top" align="center">


  <div id="titleCompact">Affiliate Account  Details </div>
  <div id="contentCompact">
    <table width="100%" border="0" cellpadding="5" cellspacing="1" bgcolor="#E9EEF5">
      <tr id="formHeader">
        <td><strong>Modify Affiliate Account Details </strong><strong></strong></td>
      </tr>
      <tr>
        <td align="center" bgcolor="#FFFFFF"><table width="400" border="0" cellspacing="0" cellpadding="4">
            <tr>
              <td width="130" height="30">Company Name:</td>
              <td width="354"><input name="companyName" type="text" class="formFields" id="companyName" size="40"></td>
            </tr>
            <tr>
              <td height="30">Contact Name:</td>
              <td><input name="contactName" type="text" class="formFields" id="contactName" size="40"></td>
            </tr>
            <tr>
              <td height="30">Email Address: </td>
              <td><input name="email" type="text" class="formFields" id="email" size="40"></td>
            </tr>
            <tr>
              <td height="30">Phone:</td>
              <td><input name="phone" type="text" class="formFields" id="phone" size="40"></td>
            </tr>
            <tr>
              <td height="30">Username:</td>
              <td><input name="username" type="text" class="formFields" id="username" size="40"></td>
            </tr>
            <tr>
              <td>Password:</td>
              <td><input name="password" type="password" class="formFields" id="password" size="40"></td>
            </tr>
            <tr>
              <td>Confirm Password:</td>
              <td><input name="password" type="password" class="formFields" id="password" size="40"></td>
            </tr>
            <tr>
              <td>&nbsp;</td>
              <td><input type="submit" name="Submit" value="Modify Account Details"></td>
            </tr>
        </table></td>
      </tr>
    </table>
  </div>


  <br>
  <div id="contentCompact">
    <table width="100%" border="0" cellpadding="5" cellspacing="1" bgcolor="#E9EEF5">
      <tr id="formHeader">
        <td><strong>Modify Payment Details </strong><strong></strong></td>
      </tr>
      <tr>
        <td align="center" bgcolor="#FFFFFF"><table width="400" border="0" cellspacing="0" cellpadding="4">
            <tr>
              <td width="130" height="30">Select Payment Method:</td>
              <td width="354"><select name="select" class="formFields">
                <option selected>Direct Deposit</option>
                <option>Pay By Cheque</option>
              </select>              </td>
            </tr>
            <tr>
              <td height="30">Bank Name: </td>
              <td><input name="bankName" type="password" class="formFields" id="bankName" size="40"></td>
            </tr>
            <tr>
              <td height="30">Name On Account: </td>
              <td><input name="bankAccount" type="password" class="formFields" id="bankAccount" size="40"></td>
            </tr>
            <tr>
              <td height="30">BSB:</td>
              <td><input name="bankBsb" type="password" class="formFields" id="bankBsb" size="40"></td>
            </tr>
            <tr>
              <td height="30">Account Number: </td>
              <td><input name="password5" type="password" class="formFields" id="password5" size="40"></td>
            </tr>
            <tr>
              <td height="30">GST:</td>
              <td><input name="gst" type="checkbox" id="gst" value="checkbox"> 
                I am eligible to collect GST </td>
            </tr>

            <tr>
              <td>ABN:</td>
              <td><input name="abn" type="password" class="formFields" id="abn" size="40"></td>
            </tr>
            <tr>
              <td>&nbsp;</td>
              <td><input type="submit" name="Submit2" value="Modify Payment Details"></td>
            </tr>
        </table></td>
      </tr>
    </table>
  </div></td>
</tr>
</table>
</body>
</html>
